Believe Them the First Time

I remember the first time someone threatened to kill me. It was my day off, so I was not in the clinic that day; a Children’s Hospital specialty group was working there instead, and after a staff member called the police, she notified me.  A father had walked in saying he wanted to kill me for “taking his children away from him.”  Wracking my brain as to this man’s identity, I drew a blank. 

The police found him in a local park a short time later and judged him to be “harmless.”  Somehow, I did not share their reassuring sentiment.  I figured out who the man was, tracked down his mother, and promptly explained the situation.  She provided a recent photograph so my staff could be trained to recognize him and contact the authorities the moment he entered our building.  That photograph still hangs in our “Most Wanted” section of my front office, amongst other pictures which have been added.  Occasionally, I request an updated picture to make sure we are keeping our office environment safe. 

The second time a parent threatened my life was over the phone. 

I was taking call on the weekend for a group of pediatricians.  One of them had evaluated a child for a finger injury and had not quite done their due diligence.  It sounded infected and in need of repair as the father described its appearance over the phone.  I recommended he take his daughter to the local Emergency Room.  He threatened to stab me instead.  I called to warn the ER staff and then notified the other practice.  The response was less than vigorous from my call partners, “you must have done something to upset him.” Their reaction astonished me; “blame the victim” is an unacceptable response to a colleague in this situation.    

When a patient or disgruntled coworker threatens to kill us, that threat should be taken very seriously.  Physicians must become less tolerant. Tolerance is defined as an objective or permissive attitude toward opinions, beliefs, and practices that differ from our own.  In my opinion, the administration of hospitals and some large clinics are far too permissive of violent threats against their staff.  I have heard numerous stories from across the country of physicians being told the patient is always right as patient satisfaction scores reign supreme. 

We have been taught when a patient threatens to commit suicide, we take them at their word.  Why is it any different when our very own lives are at stake?  The idea that physicians, nurses, pharmacists, and ancillary medical staff are expendable is ridiculous and policies must be enacted to protect the lives of medical personnel.

As I reflect on the tragic events that unfolded inside the Bronx-Lebanon Hospital last weekend, it is difficult to comprehend. My first thoughts are for the victims and their families, in particular those who knew Dr. Tracy Sin-Yee Tam.  She was a family practice physician in the hospital that day by chance, filling in for a colleague.  My second thought is to recall a quote from Maya Angelou, “When people show you who they are, believe them the first time.” 

According to the New York Times, Dr. Henry Bello had a background which spelled trouble right from the start.  His life story reveals a chaotic trajectory of bankruptcy, alleged addiction, workplace difficulties, homelessness, and brushes with the law.  He declared bankruptcy in 2000.  In 2004, Dr. Bello was charged with unlawful imprisonment and sex abuse involving a 23 year old woman in Manhattan.  In 2009, there were allegations of unlawful surveillance when he was caught using a mirror to look up the skirts of two women. 

In 2014, he was hired by Bronx-Lebanon Hospital as a family practice physician with a limited medical license and in February 2015 was forced to resign in lieu of termination after an allegation of sexual harassment.  After his resignation, Dr. Bello warned former colleagues he would return someday to kill them.  On Friday, June 30, he exacted his revenge, entering the Bronx-Lebanon Hospital carrying an AR-15 rifle and opening fire — fatally shooting a physician and wounding six others before killing himself.  Something more should have been done about this man to protect the hospital staff and patients. 

This post was not penned to  Monday-morning-quarterback the events of last Friday.   I want to emphasize in the future, these threats should be taken seriously and closely monitored to keep those inside the hospital, medical facility, or clinic walls safe.  Two hours before the shooting, Dr. Bello emailed the New York Daily News to say the allegations that ended his medical career were “bogus.”  He stated, “This hospital terminated my road to a licensure to practice medicine.”  In addition, a week prior to the rampage, he was reportedly fired from his job assisting AIDS and HIV patients by the city.  This was a clear sentinel event and foreshadowed the possibility of something ominous. 

Physicians on the front-lines are facing a battle for their survival, literally and figuratively.  Friday, June 30, I lost a physician colleague in a senseless tragedy.  We do not handle threats haphazardly when they occur in airports, schools, or police stations.  We cannot properly care for a patient when we are in fear for our lives.  It should not be tolerated any longer.  There are many valuable lessons to be learned from the events of June 30th. We need to sit up, pay attention, and make changes.  The loss of Dr. Tracy Sin-Yee Tam and injuries to the other victims should not be in vain; physicians and other medical staff deserve to feel safe in their work environment while trying to save the lives of others. 

My sincere condolences go out to the friends and family of everyone inside the Bronx-Lebanon Hospital that day.  May you find peace, hope, and healing and may we, as collective communities of healers, refuse to tolerate serious threats to our lives, those of our colleagues, and those of the patients we serve. 

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10 replies »

  1. You are absolutely correct. However, the world holds physicians far more accountable than they do the government. It is too bad. What the government does affects a far greater number in the long run….

  2. It is a very interesting question. We are an open carry state, so I have many moms who carry a gun in a holster during appointments. To be honest, knowing many of them so well, it is comforting to know they would be on my side in the event of an unexpected shooter entering the building. I am not personally comfortable carrying a weapon while examining patients, but I often wonder whether physicians carried weapons in the Wild West while working as a lone physician? Seems reasonable in light of all the house calls they were making that they would run into wild animals along the journey and other assorted characters.

  3. Any physicians conceal carrying a firearm? I don’t but am considering.

    More frequent stories about disgruntled patients/physicians/employees showing up at the workplace with their own firearm and using it.

    In a hospital, there are (presumably) armed security personnel. What about an office or clinic? A shooter in a large private practice office could be devastating. A physician or staff member carrying might save the day. Similar to schools.

  4. Ouch! Was a mental health tech in Philly. Same stuff there. Got stabbed twice, different patients, shot at and had to disarm several patients and family. No one wanted to pay for adequate security. (We actually had no security people at one of the places I worked.) That was in the days when state hospitals were closing down. We sometimes had to hold patients for days while waiting for beds to open up. We were pretty severely outnumbered many times. It only got better, and even then not a whole lot, when the place became unionized. Then we were allowed to have extra help if we reached a critical number of people we were holding. (This was a private entity licensed by the city.)


  5. No. This is the reason for the disconnect.

    The “well paid” is a thing they have in their brains that they can’t get rid of.

    The thinking is “Um. Okay. Whatever. Clicking a few check boxes. Submitting a few forms. They’re well paid. They’ll get over it.”

    Never mind that the world has changed, never mind that tech and spectacularly incompetent government regulation have completely fucked up the system to the point that it is no longer a functioning system

    Doctors get sued when the fuck up diagnoses this badly.

  6. Correct John. The colossal divide between admin and front line professionals is staggeringly vast. This post is just another example of that fact. It does play into the “get over it” mentality, though you lost me at “well paid.” Another disconnect. 🙂

  7. I think this plays into “Whatever, you’re doctors. It’s your job. You’re well paid. Get over it.” theme. This is a uniquely American cultural attitude that explains many of the problems we have in American medicine …

    The other problem is that there is a cultural disconnect between administrators and front line healthcare professionals. This is a much bigger problem than people acknowledge. Why? Because it’s easier not to talk about it.

  8. I’m so sorry you have had these experiences. You are not alone. On a Facebook group of physicians, there were more than 250 instances across the country where their lives were threatened, they were hit, punched, kicked or sustained lasting injuries as a result of patient encounters or those with disgruntled co-workers. We must change this system. Thank you for reading.

  9. I worked for many years as both a mental health caseworker and a community mental health clinician in the Bronx, Brooklyn, and in Manhattan. My life was repeatedly put at risk by the non-profit corporations I worked for, corporations whose clinics or case management operations were either licensed or certified by New York State. My OHSA complaint against a so-called “non-profit” case management agency went nowhere. That agency was sending me into the homes of suicidal and/or homicidal patients with NO safety plan or backup whatsoever. My employer rarely knew where I was or if I was safe and apparently could have cared less. I was sent into homes in the most dangerous neighborhoods in the city. OHSA’s Washington lawyers refused to prosecute what their own NYC-based investigator thought to be a solid case.

    When I worked with the developmentally disabled, I had to work in a closet, alone, with male adults one of whom acted out sexually with women. Had he chosen to rape and kill me, no one would have heard my screams for help. Since the closet was in a noisy work center, nothing that happened behind that closed door would have been heard. I was often petrified but what could I do? I needed a paycheck. I had already learned that a state-certified agency was allowed to put my life at risk and then fire me for complaining about it. I already knew that the State did not consider my safety worthy of its attention. So, I had no choice but to allow yet another state-licensed clinic put my life at risk every day (the other “choice” was to stop eating). Eventually, I couldn’t take the abuse and neglect anymore, stuck my neck out again, and that time, since I was an independent contractor, my contract was suddenly “terminated.”

    I then worked in community mental health with the mentally ill chemically addicted. As one can imagine, with that population, we often had to deal with drug-seeking individuals who were extremely dangerous and threatened staff. There was no security even with such a dangerous population, and it was not unusual that our patients attacked each other. The police were called afterwards, but there was no one to stop these attacks when they happened.

    When I was threatened by a client and fighting against being locked in my office with him, the only person I could count on to help me, our janitor, laughed. To be fair to him, he wasn’t a security guard. He was probably very nervous, and didn’t know what to do. I think, though, that he didn’t choose to believe that it was possible I was at risk in that moment because then he would have had to take responsibility to make a choice and actually DO something. And that something might have cost him his job if the client had complained. So better risk my life than his job or the client’s rights or dignity.

    We often get our heads chopped off when we stick our necks out in situations like these. Dr. Al-Agba is right on point. I blame New York State for the Bronx-Lebanon deaths and injuries. My entire career in New York showed me that the state turns a blind eye to the constant danger healthcare employees are exposed to. New York State cannot possibly have any type of requirements that these facilities have adequate security because if they did, I would not have been placed in such needlessly dangerous situations across the board and in every single agency I worked with.

    Profits came before protection, and it’s not much of a leap to assume that they still do. Let’s not kid ourselves about that. It will take a motivated legislator who actually cares about constituents for this to change. Who could that be I wonder? Denial is a powerful thing, and so is inertia.

    There’s only one thing we can all be assured of and that’s that more people will die.

  10. “The loss of Dr. Tracy Sin-Yee Tam and injuries to the other victims should not be in vain”. Agreed!
    The Chief HR person should be fired. The pharmacy technician “doctor” should never have been hired. I am not a fan of tort lawyers/lawsuits….but this is a perfect example of a case where Dr. Tracy Sin-Yee’s family needs one fast….and a major civil award for gross negligence will be a signal to other organizations.